RNC: And Now for a Different Take on Obamacare ACA

Reform, not repeal, urged by former HHS Secretary

CLEVELAND -- Could a Republican administration repeal Obamacare? That was the topic up for discussion at a briefing Tuesday, held outside the Republican National Convention.

"I do not believe ... that my political party is going to be able to put together a complete repeal, and I don't think it should," said Tommy Thompson, JD, a fellow of the Council on Foreign Relations, who served as Secretary of Health and Human Services under President George W. Bush, and four terms as governor of Wisconsin.

He said attempting full repeal would create "real chaos. The Affordable Care Act has got lots of problems, but there's some good parts of it, and most Republicans will recognize the good parts," he told reporters after the briefing.

Republicans should focus on fixing Obamacare, by reducing its taxes, lowering premiums, and giving people an incentive to buy health insurance, he said.

"Why is it that you and I don't get a tax deduction when we pay for health insurance, but the company that employs us does?" he said at the briefing.

Thompson argued for giving everyone a refundable tax credit to incentivize more people to buy into plans. He also said that the government should maintain parity laws, so that sick people aren't charged more or kicked off their health plans -- he called the latter move "un-American."

When asked who the best person would be to navigate these "meaningful changes", Thompson didn't hesitate: "Without a doubt, Donald Trump."

"Donald Trump would be well-advised to outsource the making of policy to [Speaker] Paul Ryan (R-Wisc.)," said Lanhee Chen, PhD, JD, a research fellow at the conservative think tank, the Hoover Institution at Stanford University in Stanford, Calif. Chen was also the policy director for the Romney-Ryan 2012 campaign.

"Presumably, that's what would happen," he said, and then clarified "In an ideal world for conservatives, I think that's what would happen."

"I think we are in a phase of the conversation now, where we're trying to do our best to imagine what a Trump administration would look like, when in reality, none of us really knows. This is like a freak wild card," he stated.

Chen told MedPage Today, that full repeal would be "tough" but "a large amount of repeal" could happen through the budget reconciliations process, which requires fewer votes -- a path that has already been tested.

If Trump wins the election, Chen anticipates a Republican administration would attempt repeal.

"It's important for him to realize that just saying you're going to repeal Obamacare alone is not enough, that there has to be a coherent plan to replace it," he said, which is where turning to Ryan's blueprint makes sense. "Otherwise, politically I think he's in very dangerous water."

If repeal weren't achieved, Chen argued for developing more tailored plans to fit people's needs that cost less, made possible by loosening some of the essential benefits requirements; paring back subsidies; developing a more "open architecture" to create a more competitive marketplace; and giving states more flexibility around Medicaid expansion on the front-end, instead of relying on the back-door 1115 waiver process.

If Secretary Hillary Clinton wins the presidency and Republicans maintain a majority in Congress, "they'll want to try to work together," Chen said. "It will be incumbent on [Senate Majority Leader] Mitch McConnell (R-Ky.) and Paul Ryan to lead that negotiation with her."